Wanderings Pertaining to My English Thesis

Sunday, April 22, 2012

“Words as Maps”: Rethinking the Collectivity of
Women’s Life Writing with Marya Hornbacher’s Wasted: A Memoir of Anorexia
and Bulimia

Cassie Ann Kosarek

Bryn Mawr College Class of 2012

23 April 2012

Department of English

Marya Hornbacher’s memoir, Wasted: A Memoir of Anorexia
and Bulimia, uses several different
pronouns (“I,” “you,” “we”), to present a multiplied identity, and so
challenges the conventional boundaries of clinical literature. I read
Hornbacher’s memoir, drawing on the fields of medical humanities and
disabilities studies, to show how the tradition of women’s life writing can be
expanded to describe not only the unified yet fragmented individual, but a
unified yet fragmented society.

I. Hornbacher, Eating Disorders, and the Scope of this
Project

“The words are purposes.

The words are maps.

I came to see the damage that was
done

and the treasures that prevail.”

- Adrienne Rick, “Diving into the
Wreck” (1973)

I am interested in the stories that people tell about their lives. It is a longstanding
interest, one that has combined with other interests – psychology, medicine,
nonfiction – to produce a professional trajectory that aims toward medicine,
but which resists science as the only means to get there. When I began to
conceptualize my senior thesis, I was certain only of two things: I wanted to
work with memoir – with a narrative in which an identity was shaped –, and I
wanted to combine my interest in mental health with my training in reading English
literature. From the beginning, my thesis was an interdisciplinary project. I
wanted it to be an experiment in how literature represents illness, in how
psychology explains prose, in how a text might resist linearity and other
traditional devices to, as David Shields describes, “dissolve a genre or invent
one.” I wanted to see what resulted when the lines between genres are erased. I
wanted to consider the broader readership that might result from such a move
and the practical implications of using a medicalized narrative to tell a
personal life story. In short, I had rather lofty ideas about what I wanted to
produce, but then I took a step back and realized I had no primary text.

So I began buying
memoirs, using my own interests and abstract ideas about what I wanted to write
as a guide to what I read. I learned about schizophrenia and depression,
bipolar disorder and substance abuse – but the illness stories that interested
me the most, because they seemed to reach beyond a description of a medicalized
self, were those about eating disorders. Eating disorders entailed not just
individual diagnosis, but also our sociopolitical climate and culture. I was
taken, in particular, by the complexity of the narrative in Wasted: A Memoir
of Anorexia and Bulimia by Marya
Hornbacher, who accounts for her eating disorder in nontraditional terms, and
so paints a picture of mental illness that stretches the boundaries of a
clinical narrative. Although I was hesitant to work with a memoir that detailed
an area of mental health that I knew very little about, the complexity of
Hornbacher’s memoir begged to be unraveled.

As I began to
reread Hornbacher’s text, I was struck by her wide-ranging pronominal choices.
She was “I”, “we,” “she.” At times, she was “you.” What kind of memoir, I
wondered, could be written about a self that did no speak with a concrete “I”?
How does the prognosis of an eating disorder change when its bearer resists
pronominal identity? How do popular culture and diagnostic culture clash in the
telling of such a narrative? How might both of my disciplines, English and
psychology, be helpful in untangling the maze of pronouns scattered throughout Wasted?

Eating disorders
are inherently complex, with etiological roots in neurobiology, social
surroundings, individual temperament, and the family climate; a comprehensive
view of an eating disorder is complex requires multiple seemingly contradictory
theories to explain its many layers. According to the Diagnostic and
Statistical Manual of Mental Disorders, Marya
Hornbacher would be diagnosed with Anorexia Nervosa – Binge/Purge Subtype. To
meet criteria, Hornbacher must maintain a weight at less than 85% of her ideal
body weight, must have an intense fear of gaining weight despite being
underweight, must have a disturbance in the experience of her body shape and
weight, and must have amenorrhea, or lack of a menstrual period (DSM). To meet
criteria for the Binge/Purge Subtype, she must also regularly engage in
binge-eating or purging behavior, which may include self-induced vomiting and
laxative abuse (DSM).

Researchers have
identified several environmental and personality traits that many anoretics
have in common. The prototypical anoretic is female and comes from an
over-involved, enmeshed family, in which there are unclear boundaries between
parents and children (Neeren). She perceives herself as having little control
over her external environment and thus controls her food intake (Neeren). The
anoretic is often perfectionistic, rigid, obsessive, and unwilling to assert
her voice or opinion for fear of causing interpersonal upset; those anoretics
who also binge and purge are also typically impulsive and thrill-seeking
(Neeren). One or more of her relatives may have been diagnosed with an eating
disorder, as relatives of people with eating disorders are four times more
likely to develop the disorders themselves (Neeren). Further, she likely has a
family history of mood disturbances and may have a comorbid depressive or
anxiety disorder herself (Neeren).

I explored a
number of different theoretical perspectives on eating disorders, first working
my way through the clinical literature on the disorders, before settling on
three fields – the medical humanities, disabilities studies, and the tradition
of women’s life writing – that were most useful in helping me understand how
Hornbacher represents eating disorders. By extension, and in juxtaposition with
one another, these three fields also made clear to me how practitioners in the
humanities can help those in the medical field better understand their
patients.

Narrative medicine
offered me an entrée into the field of medical humanities, which enlarges the
scope from stories of individual patients to include the story of medicine
itself, looking to offer the most comprehensive healthcare through reformed
thought about diagnosis and treatment. In particular, Rita Charon’s work in
narrative medicine (she trains physicians to attend to the ways in which
patients tell their stories, and how those stories can be used to contribute to
more accurate diagnoses and treatments as well as greater empathy) gave me a
way to read Hornbacher’s clinical explanations of her illness – an enmeshed
family pattern, a history of mental illness, an impulsive personality.

Because medical
humanities is primarily focused upon reforming from the traditional medical
structures from within and because Hornbacher’s text addresses not only
medicalized representations of her illness, but the sociopolitical dimensions
of it as well, I found it necessary to widen my theoretical scope by
considering both field of disabilities studies and the tradition of women’s
life writing. Disabilities studies is concerned with the cultural construction
of illness, and focuses on the ways in which the structure of abilities that we
call disables those with physical and mental differences. Disabilities studies
resists medicalization as a particular way of categorizing and coping with such
difference. The field draws on the framework of feminist theory (among others),
and, in my analysis of Hornbacher’s memoir, I also found myself drawn toward
theories about women’s life writing, which both consider the oppression that
results from inhabiting a disadvantaged body, and examines how this oppressions
(and resistance to this oppression) is represented in the narrative female
voice.

In the following
project, I seek to follow Rich, using words as “maps” and “purposes” to uncover
the “treasures that prevail.” By situating myself within these three
theoretical orientations, I suggest that texts like Hornbacher’s map not only
individual lives, not only women’s stories, but the particularity of genre in
which those stories are told.

II. Placing Hornbacher in “The Field”

A. Medical Humanities

As Evans et al.
explains in their overview, Medical Humanities: A Practical Introduction, in the 1960s, questions arose about the “underlying
authority of modern scientific medicine” (3), which at the time was grounded in
“biomedicine,” or “the overall trend . . . for the patient narrative gradually
to disappear in favor of technical investigation, for symptoms to give way to
disease entity, and for treatment to become non-negotible” (11). This crisis
was fed by

the emergence of the
anti-psychiatry movement; the inability of science and technology to deal
effectively with many chronic and disabling conditions, despite escalating
levels of public expenditure on healthcare; and an awareness of the personal
insensitivity of much of modern medicine and its failure to take account of the
patient’s perspective (13).

A growing movement toward reform of
medical practice catalyzed the development of the field of medical humanities.

David Greaves
defines the humanities as “subjects concerned with the uniqueness of
individuals rather than generalization” (15). This definition of the
humanities, when taken in a medicalized context, challenges the
depersonalization and institutionalization of diagnosis and begs for a return
to individual narratives. Greaves “equates” the medical humanities “with the
medical arts” (18), to which the practices of science and technology are
subordinated (14). Greaves depicts these medical arts as a counterbalance to
biomedicine, and conceptualizes medical practice as a balance of arts and
science that

focuses on the human as relevant to
the whole of medicine and so cuts across the traditional formulation of western
medicine as comprising separate realms of art and science, with the human
aspects restricted mainly, if not exclusively, to the former (18).

By defying the binary between the
sciences and the arts, the medical arts offer “an innovative and unified
approach” to medicine that reconsiders medical theory and urges “practitioners
to develop a more rounded and humane attitude to their practice” (Greaves 19).
Just as Greaves considers both the macro- and microscopic implications of
involving the humanities in science, I will consider the implications of a
reformed medical narrative on both an individual and societal level in my
analysis of Hornbacher’s text.

Richard Edwards also identifies the
medical humanities as responding to generalized and impersonal theories of
medicine. Edwards points out that evidence-based medicine leads to
generalizations that do not necessarily match the needs or situation of the
individual, and that “even in ideal circumstances,” when the individual does
meet a generalized clinical picture of an illness, “it remains imperative to
address and respond sympathetically to the emotional consequences of diagnosis
and treatment” (238). Medical humanities aims to remedy such problems arising
from clinical generalization.

Edwards
reports a variety of ways the medical humanities works to reform the existing
structure of medicine. First it provides a language for patients to communicate
more effectively with their physicians, allowing them both to verbalize their
emotions concerning diagnosis and treatment and to create narratives exploring
possible courses of action (241). Next, these narratives and emotional
depictions of disease provide frameworks for evidence-based theory, allowing
physicians to reassure patients by exploring the benefits and drawbacks of a
treatment from both theoretical and emotional perspectives. Finally, the
medical humanities build upon “problem-based learning” (245); they beg for a
“questioning,” critical approach that “promote[s] reflective practice and
learning” (242). Such a complete evaluation is conducive to exploring of
alternative and complementary therapies for illness, including treatments not
as often empirically validated, such as those associated with eastern medicine
(242). Edwards also argues that it is useful

to employ published narratives or
artistic representations of ill health as qualitative input alongside actual
patients’ narrative, to widen perspective and facilitate a more sympathetic
understanding of the ‘human condition’ (237).

Published
narratives of illness work, on a grander scale than do oral, unpublished
patients’ narratives, to promote change within western medicine. In publishing
such narratives, patients develop a voice apart from medical generalizations,
fitting their personalized medical stories into the existing clinical
literature, thus expanding clinical language beyond objective descriptions of
their conditions. In published personal discourses of illness that combine
clinical and personal narratives, the field of medical humanities is made
visible. It is in such a space that I situate my own analysis of such a
narrative.

B. Disabilities Studies

But
the space created by the medical humanities is not quite large enough for the
work I want to do with Hornbacher’s memoir. When disabilities studies scholar
Margaret Price visited the Bryn Mawr College campus in February, she made a
distinction to several of us over lunch between the fields of medical
humanities and disability studies. While the medical humanities arose from
within medical schools and thus look to reform medicine from the inside,
disabilities studies is the academic branch of a social activist movement that
both models itself on past movements (such as those for civil and women’s
rights) and positions itself uniquely, and primarily, as a critique of the
“medical model” of disability. As Lennard Davis elaborates on this distinction,
disabilities studies is “both an academic field of inquiry and an area of
political activity” that “aims to challenge the received in its most simple
form – the body – and in its most complex form – the construction of the body”
(xv-xvii). Even more broadly, Susan Wendell explains, the field critiques the belief
that “the world [is] structure[d] for people who have no weaknesses” (243); it
posits, instead, that weakness is a socially constructed paradigm, based upon
an unspoken, implicit archetype of the “perfect” body that all humans strive to
achieve.

Only in the past
few decades have disabled individuals begun to organize themselves politically;
a major accomplishment of the Disability Rights movement was the passage of the
Americans with Disabilities Act in 1990 (xvi). Emerging work in disabilities
studies drew both on this social movement and on academic work in feminist
studies, sociology, and philosophy, by scholars such as Jacques Derrida, Judith
Butler, Susan Bordo, Erving Goffman, and David Rothman (Davis xvii). As Davis
explains, the “work of a newer generation of writers and scholars looks toward
feminist, Marxist, postmodern, and cultural studies models for understanding
the relation between the body and power” (xvii).

But this next
generation of writing is also distinct in that it “tends to be created from
within the boundaries of disability” (xvii). It does not attempt to “share” the
disabled experience with normative audiences, but rather shuns the inherently
unequal balance between disabled and able-bodied that occurs when works are
“sensitized” so as to evoke sympathy from a normative audience (xvii). By
upending this power dynamic, disabilities studies scholars avoid the “advocacy
trap” that promotes emotive, sympathetic understanding at the cost of
reinforcing cultural conceptions of disability as weakness and as disadvantage.
It thereby creates room for critical inquiry into difference

Davis explains
that disability has traditionally “been seen as eccentric, therapeutically
oriented, out-of-the-mainstream, and certainly not representative of the human
condition” (xv); it has been treated much in the way that “race, class, and
gender have been theorized” (xvi), placed in a unique sociopolitical cultural
context and understood as a request for special needs. The field of disability
studies constructs a counter-narrative by placing individual difference in
social and political context, and identifying oppression as a social
construction that needs to be de-institutionalized. The field focuses on the
power dynamics between the social norms of ability and individuals unable to
meet those norms, who are thus exposed “to inspection, interrogation,
interpretation, and violation of privacy”; “people with anomalous bodies are
often called upon to account for them, sometimes quite explicitly: they may be
asked, ‘What happened to you?’ ” (Couser
400).

Susan
Wendell points out that the given definitions of “disability” and “handicap”
are dependent on recognition of the normative (245), and that “[p]aradigms of
health and ideas about appropriate kinds of levels of performance are
culturally dependent” (245). The United Nations defines disability as “[a]ny
restriction or lack (resulting from an impairment) of ability to perform an
activity in the manner or within the range considered normal for a human being”
(244). Handicap, which refers to the social disadvantage resulting from
disability, is “the loss or limitation of opportunities to take part in the
life of the community on an equal level with others” (24s4). Thus, social
function is inextricably linked to social constructs, like disability, that
allow for “normative” experiences of society. Wendell explains that because
social conceptions of disability are so dependent on context, “we might
eliminate the category of the ‘disabled’ altogether, and simply talk about
individuals’ physical abilities in their social context” (245). Disabilities
studies examines functionality within cultural confines and asks how degrees of
functionality may contribute to a given culture.

This
is the particular focus of Ray McDermott and Herve Varenne, who show how, when
a culture selects certain features that it values, such as academic
achievement, it disables those who cannot achieve in that arena. For example,
the advent of the radio presumed that the normative, able-to-hear majority
would benefit from receiving information in this manner – and thus excluded
those who were deaf from a new source of news and entertainment. McDermott and
Varenne argue that such social inventions, which enable one portion of the
population, disable others by denying them some degree of social functionality.

According
to other disability studies scholars, the field of medicine is particularly
egregious in this regard. Wendell shows how contemporary medicine “plays into
and conforms to our cultural myth that the body can be controlled” (249).
Doctors are “trained to do something to control the body” (250) – the body must
bend, under various therapies, to the will of the physician, who aims to return
the body to a cultural norm. Wendell labels this the “heroic approach to
medicine” (250), a method in which “[m]edical professionals have been given the
power to describe and validate everyone’s experience of the body” (253).

Feminist
disability theory has been particularly crucial in advancing this argument. As
Rosemarie Garland-Thompson explains, “The fundamental premise of Disability
Studies is that disability is a culturally fabricated narrative of the body, a
system that produces subjects by differentiating and marking bodies” (1). Her
analysis of the field draws together feminist rejection of the cultural
narrative of the female identity and body with disabilities studies’ rejection
of the narrative of the disabled identity and body:both force us “to realize that other people have more social
authority than you do to describe the experience of your own body” (254).

Combining the two
fields into what she refers to as “feminist disability critical theory,”
Garland-Thompson outlines a methodology for reading the narratives of disabled
women, which draws on these fundamental premises:

that representation structures
reality; that the margins define the center; that gender and disability are
ways of signifying relationships of power; that human identity is multiple and
unstable; and that all analysis and evaluation has political implications. (6)

It is this approach to the disabled
female condition – that society has constructed gender as a disability, and
that a disabling gender and a traditional disability are inseparable when
critically viewing a disabled woman – on which I will draw in my examination of
Hornbacher’s memoir. In my reading of Wasted, I will use disabilities studies as a reflective field that sheds
light on the constructions that either name or cause disability. For the
purposes of my paper, disabilities studies will be a means of explaining eating
disorders outside of the clinical literature. It helps explain how culture is
constructed in such a way as to facilitate the development of these disorders,
and to explore how society might cope with these disorders in non-clinical
ways.

Disabilities
studies has a particularly useful relation to theories of autobiography and
representation. As Couser explains, the “cultural representation of disability
has functioned at the expense of disabled people, in part because they have
rarely controlled their own images” (399). In contrast to these historic
practices, disabled people have more recently “initiated and controlled their
own narratives” (399). This writing, Couser suggests, should be considered a
“retort” to “misrepresentation of disability”: the writing resists the cultural
narratives that are “inscribed” on the bodies of the disabled (400). Margaret
Price illustrates Couser’s idea by describing the ways in which, by showing a
multiplicity of selves through the deliberate confusion of a narrative “I,”
autobiographical writing by disabled individuals creates a culture of
counter-diagnosis that defies the framework contributing to the
institutionalization and oppression of individual difference.

Integrated with
cultural and personal narratives of disability and gender, and challenging of
traditional medical structures, disabilities studies contributes some key
insights to my interpretation of Hornbacher’s representation of eating
disorders, which stretch beyond the clinical and the personal. I use
disabilities studies as a lens that expands medical humanities to include the
sociopolitical and cultural aspects of illness. Trained on the genre of women’s
autobiographical writing, both fields enable me to show how medicalized
narratives might be expanded to consider a larger range of diagnostic
implications.

C. Women’s Life Writing

Theorists
of feminist autobiography include various nonfictional forms – memoir, letters,
diaries, and autobiography – in the overarching genre of life writing (Smith
and Watson). The subtitle of Wasted: A Memoir of Anorexia and Bulimia deliberately situates Hornbacher’s work within the
genre of women’s life writing. Women’s life writing is derived from the male
autobiographical tradition, which stresses “the defense and glorification of a
man, career, a political cause, or a skillful strategy” (Benstock 8). For many
centuries, female autobiography reflected a reinforcement of the “token woman”
– the inevitable response to the “masculine man” as presented in male
autobiography –(Heilbrun 16) and
a continuation of the “one plot” available to women, which ended either in
marriage or death (17). Women’s autobiography was traditionally “sentimental
and passive” (19), bringing out only the expected behaviors for the public to
see, while keeping private all messier goals, hopes, and angers.

The
tradition of women’s life writing, however, developed another stream – that of
confessional writing, which, with its emotive and tell-all nature, defied the
conventional male literary script within which women’s autobiography operated.
Writing confessions enabled women to express their “uninhibited
autobiographical impulses” (23). Such writing created a “rhetoric of
uncertainty” (18) that today often characterizes women’s life writing. Unlike
male autobiographical writing, women’s life writing “has become an exploration
of painful experience rather than denial of pain and struggle” (25), moving
outward from introspection and extending their experience to a larger
population (Heilbrun 24, Benstock 8).

In
its defiance of the masculine autobiographical tradition, feminist scholars see
women’s life writing as inherently politicized. The act of confession, of
making the private public, turned women’s autobiography into feminist discourse
by integrating the political and the personal dimensions of life writing.
According to Estelle Jelinek, women’s “self-portraits” have long been
distinguished from men’s by their “irregularity rather than orderliness” (17),
which has expanded to include writing that seems like “a jungle of fragments”:
truncated sentences without proper subjects, perhaps consisting only of a
phrase, or even a single word, resembling “the kind of shorthand writing
characteristic of diaries and notebooks,” and perhaps interrupted by passages
that are “chronological, progressive, and strictly grammatical” (171). These
stylistic trends of women’s life writing, Jelinek argues, politicize female
texts. Other stylistic choices, including the multiplicity of the singular
subject, which Benstock places in direct contrast to the male resistance of the
“discordant ‘I’ ” (8), indicate that women have developed means of representing
their coherent, fractured, and multiplied selves outside of the traditional
prescriptive male forms.

Yet,
Helen Buss argues, because the autobiographical tradition still begs for the
singular self as subject, the female autobiographer faces a unique challenge:
experiencing herself as “fragmented, decentered, and dominated by forces
largely beyond her control,” while nonetheless presenting her autobiographical
self in a “stable, unified” way (97). Buss calls this the “doubled discourse”
of women’s life writing (97). Women must strive to satisfy the demands of the genre
while faithfully representing their politicized bodies and identities. The
fragmentation in women’s life writing, then, reflects the feminine politicized
self, acknowledging a history of oppression and disabling cultural forces while
speaking for both the unified “I” and a larger female majority.

I here consider
Hornbacher’s memoir as an example of this kind of complexly negotiated women’s
life writing, and will evaluate it within this history, as an example and
possible extension of a genre with a long historical lineage. The tradition of
women’s life writing represents the theoretical capstone to my three areas of
interest, as I will use it to explain how Hornbacher’s text ultimately
represents an expanded form of clinical literature.

III. Explaining Pronomial Use in
Wasted

In
Wasted: A Memoir of Anorexia and Bulimia,
Marya Hornbacher claims that she is committing “cultural heresy” (5). Through
her analysis both of her eating disorder and what it takes to recover, she
violates long-standing ideas about femininity and wellness in order to embrace
a clinical picture of her disorder that encourages her to say, “I will eat what
I want and look as I please and laugh as loud as I like and use the wrong fork
and lick my knife” (5). Much of what Hornbacher accomplishes in this clinical
depiction of herself as an eating-disordered patient, and her rejection of
cultural standards in favor of biological health, stems from her
interchangeable usage of first-, second-, and third-person voices, which aim to
shed light on the texture of eating disorders as both mental illness and
cultural phenomenon. The memoir never settles on a distinct pronominal “I.”
Rather, the text speaks to “you”, the reader(s); to “her” or “them,” the
eating-disordered individual(s); to “us” or “we,” the eating-disordered
collective or community. “I,” the ostensible bearer of the narrative, seems to
surface only when particular details of the life in question are too specific
to be attributed to “you,” “her,” “them,” “we” or “us.”

I
will examine a few exemplary passages in which this pronominal switching is
particularly important and apparent, although Hornbacher employs the technique
regularly throughout the memoir, following a fairly consistent pattern.

The
first passage I want to discuss occurs early in the memoir, in the
introduction, and so functions as evidence of how quickly Hornbacher delves
into this unique pronominal usage. Hornbacher begins her first description of
the cognitions and cultural influences behind eating disorders in
second-person, thereby both tagging us readers as eating-disordered, and
telling us what we think about “our” shared condition. An eating disorder, she
explains,

is . . . an attempt to find an
identity, but ultimately strips you of any sense of yourself, save the sorry
identity of “sick.” It is a grotesque mockery of cultural standards of beauty
that wind up mocking no one more than you. It is a protest against cultural
stereotypes of women that in the end makes you seem the weakest, the most needy
and neurotic of all women. It is the thing you believe is keeping you safe,
alive, contained . . . An eating disorder is in many ways a rather logical
elaboration on a cultural idea. While the personality of an eating-disordered
person plays a huge role – we are often extreme people, highly competitive,
incredibly self-critical, driven, perfectionistic, tending toward excess - . .
. I do believe that the cultural environment is an equal . . . culprit in the
sheer popularity of eating disorders. .
.I chose an eating disorder. I
cannot help but think that, had I lived in a culture where “thinness” was not
regarded as a strange state of grace, I might have sought out another means of
attaining that grace, perhaps one that would not have so seriously damaged my body,
and so radically distorted my sense of who I am (6-7).

By page six, Hornbacher conflates
herself, an eating-disordered individual as “you,” with a layered narrative
identity. Her claim that the consequences of her eating disorder “radically
distorted my sense of who I am” (7) create the space for her to oscillate
between narrative identities, allowing her to become, by turns, the patient,
the feminist, and the pedestrian onlooker all working against containment
within one memoric self.

Traditionally,
non-feminized forms of autobiography and its subgenre, memoir, contain the life
narratives of a singular person. By using multiple pronouns to tell her
narrative, Hornbacher challenges this traditional masculine sense of memoir,
embracing instead what Jelinek describes as the tradition of presenting “a
multiplicity of selves” within a feminine autobiographical text. Hornbacher
extends her experience to the reader by demanding that “you” emotionally
empathize with the consequences of distorted eating-disordered cognitions,
which in this passage are cast as general thoughts characteristic of all
eating-disordered patients. Hornbacher does not write, “I felt safe in my
eating disorder;” she asserts instead that “you” are “safe,” “alive,” and
“contained” (6), thereby forcing her audience to emotionally identify with her
experience. Hornbacher thereby creates an emotionally shared narrative, thus
including multiple identities – her own and those of her readers – into her
work in an act that makes explicit the multiplicity of identities that
characterizes women’s life writing.

Hornbacher’s
“you” extends the “disabling” cognitions of having an eating disorder to
the“non-disabled” majority. “You”
is used empathetically, forcing readers to share the experiences of an
eating-disordered individual, to explore the cognitions and the unarticulated
emotions that come with those cognitions. It is not Hornbacher or a woman in
inpatient treatment who seems the “most weakest” (6) – it is “you.” The reader
is forced to become an anoretic, to adopt the “sorry identity of ‘sick’ ” (6).
Hornbacher links this explicit demand that the reader empathize with – if not
actually become – eating-disordered, with a brief mention of the “cultural
standards of beauty” (6) that reinforce eating-disordered behavior. In doing
so, she builds on what McDermott and Varenne argue in “Culture as Disability,”
that culture constructs disability to show that both “you” and “I” experience
social disability in the same way.

Although
Hornbacher uses the pronouns “you” to force her readers into occupying the
space of disability with her, she turns to “we” in the same passage, and
thereby pushes us away, inviting “you” to become a voyeur of “our” competitive
perfectionism. Throughout her memoir, she draws the picture of an
eating-disordered community – in her words, a group of “extreme people” (6)
whose intensity not only feeds into their athletic, creative, occupational, and
academic lives, but into honing their eating disorder. Amy Neeren, my psychology
professor at Haverford College, told me that, in her clinical practice, she
sees a tendency of eating-disordered individuals to compete with each other to
“perfect” their disorders. They want to have the “best” eating disorders. They
want to be the thinnest, eat the least, and, most notably, they want to exclude
others who do not possess like disordered behaviors and cognitions. As
Hornbacher implies when her pronouns shift from “you” to “we”, outsiders do not
combine self-starvation or purgation with self-criticism and perfectionism.
Outsiders do not attain “grace” (7) in the difficult-to-maintain
self-destruction of “true” eating-disordered individuals. In beginning this
passage with the pronoun “you,” Hornbacher signals that we readers are affected
by the disabling cultural ideals that catalyze disordered eating. But in
shifting quickly to “we,” Hornbacher breaks down the empathetic connections
she’s just built with her readers, excluding “us” from her elite, discrete
community. She thus isolates eating disorders as an abnormal response to the
collective culture in which “you all” live. “You” do not have the personality,
the family climate, the sheer drive needed to maintain eating disorders. “You”
are invited to behold “we,” but clearly do not participate in “our” thoughts
and behaviors.

As
the passage continues, Hornbacher continues to narrow the experiential
component of her narrative, switching next from first person plural to first
person singular voice, lighting momentarily on “I” to describe her own
particular experience. The use of “I” denotes the kind of agency that,
clinically, is not supposed to be present in the development of an eating
disorder. By stating, “I chose an eating disorder” (6), Hornbacher explicitly
claims that she made an active choice, as if she had surveyed the field of
clinically disordered behaviors from which she could choose and found an eating
disorder to be the most suitable. Hornbacher reports that she experimented with
a plethora of behaviors in her adolescent years (including but not limited to
promiscuity, illicit drug use, and self-mutilating behaviors), so it is
possible that she actively rejected such activities in favor of an eating
disorder. But, given the clinical evidence Hornbacher presents about
eating-disordered “personalities” – that they are “highly competitive,
incredibly self-critical, driven, perfectionistic, tending toward excess” (6) –
it is unlikely that a personality so specifically predisposed could actually be
said to “choose” to be eating-disordered. A clinical view of Hornbacher’s “I” –
with its explicit claim of an agential self –represents the delusional sense of
control associated with eating disorders. Noting an “I” arguably prone to
delusional beliefs and Hornbacher’s follow-up statement that her eating
disorder “radically distorted my sense of who I am” (7), a reader trained in
clinical psychology would interpret the effects of her “rather logical
elaboration on a cultural idea” (6) as pathological. But a disabilities studies
scholar would highlight instead the causal relationship between the culture in
which “you” live, which disables the “I.” “You” is thus both distinguished from
“we,” and yet linked to the “I” that is part of “us.” By connecting her
pronouns circularly in this way, Hornbacher encourages a less medicalized, more
socially determined understanding of eating disorders.

The nature of
Hornbacher’s “I” shifts, however, as the memoir continues. No longer decisive
and forceful, “I” becomes fitful and visceral in its actions, a catalogue of
the more mundane moments of the life the memoir is chronicling. This is the “I”
that dominates the majority of the memoir.

In a much later
passage in which this less decisive “I” appears, Hornbacher again uses pronouns
interchangeably yet skillfully, to slightly different effects:

You go insane about now. You understand, it just
happens. Crazy isn’t always what they say it is. It’s not always the old woman
wearing sneakers and a skirt and a scarf, wandering around with a shopping
cart, hollering at no one, nothing, tumbling through years in her head . . .
No. Sometimes it is a girl wearing boots and jeans and a sweater, arms crossed
in front of her, shivering, wandering through the streets at night, all night,
murmuring to no one, nothing, tumbling through the strange unreal dimensions in
her head. . . Bedtime, and the house falls darker still. I sit at the window,
waiting for the mutterings and shufflings to slow and stop. . . I hold the back
of the chair with one hand, do exercises endlessly, waiting for one o’clock.
Only four hours till morning, I think. (171-172).

Hornbacher here
again fragments her narrative self – she is first “you,” then “she,” finally
again “I.” But all three of the pronouns she uses to describe herself are
clearly differentiated from another “crazy”-appearing group, which includes the
old woman with a shopping cart. By first distinguishing aspects of herself from
one another but then posing them collectively as distinct from another group of
behaviors, Hornbacher finds a subtle, complex pronominal way of negotiating the
dilemma articulated by Buss: that the female memoirist must present herself as
stable and unified while acknowledging herself as “fragmented [and] decentered”
(97).

Hornbacher creates
a boundary between the narrator (whom she refers to variously as “you,” “she”
and “I”) and the woman with the shopping cart, as well as other characters in
the book by means of a distanced perspective on the latter. The narrator has no
apparent insight as to why the woman with the shopping cart is “hollering” or
what she thinks as she “tumbles through the years in her head” (171). The
narrator does not empathize with this “crazy” woman. Because the narrator has
no insight into the experience of the woman with the shopping cart and like
characters, there is distance between the pronouns of Hornbacher’s narrator and
this “crazy”-appearing group, thus helping to stabilize the narrator as a
coherent identity that can be separated from others.

Buss’ ascribes the
dilemma of the female memoirist to all women, whether able-bodied or not.
Hornbacher’s memoir answers Buss’s challenge, in part by complicating it with
her illness; eating disorders give a very particular “turn” to the female
memoirist’s dilemma. Couser explains that autobiographical texts about illness
may be written as a “retort” to the “misrepresentation of disability” (400).
Hornbacher makes this retort explicit when she redefines “crazy” as something
other than the conventional conception: not “always the old woman . . . hollering.
. . tumbling. . .” (171), it may well be exemplified by the ‘normal’-looking
girl who defies the social depiction of mental disability. In casting herself
as “crazy,” Hornbacher attempts to shatter preconceived notions about the face
of mental illness.

By starting the
passage with “you,” Hornbacher resists all conventional social constructions
distinguishing the crazy from the sane, those who are eating disordered from
those who are not. Mental illness, Hornbacher implies, can develop in a
‘normal’ girl in a sweater: as it enveloped the “I,” so can it emerge in “you.”

Using these three
pronouns, first identifying them as discrete from one another then intertwining
them in contrast to an “other,” Hornbacher contributes to what Margaret Prices
calls a “counter-diagnostic” culture (243). She not only challenges
conventional representations of her own mental illness, but also the social
framework in which such representations occupy a particular role. By stating
that “crazy” is not only the woman with the shopping cart, Hornbacher calls
into question our contemporary diagnostic culture, which only recognizes
insanity within a narrow range of abnormal behaviors, specifically, those
outlined by the DSM-IV-TR. Insanity,
Hornbacher’s text implies, is hard to recognize: it encompasses behaviors not
necessarily stereotyped as indicative of disorder.

Hornbacher’s
pronominal plurality both solves the conventional female autobiographical
dilemma and rebuffs the cultural construction of mental illness. Her complex
use of pronouns extends the concerns of clinical diagnosis to include the
political dilemmas of gender. Since “she” refers to a “girl wearing boots and
jeans and a sweater” (171), and since “she” is connected both to “you” and “I,”
all three pronouns are implicitly feminized. Hornbacher thereby makes it clear
that she is exploring the impact of mental disability, especially the most
feminized of all mental illnesses on a female subject.

Hornbacher writes
that she “sit[s] at the window, waiting for the mutterings and shufflings to
slow and stop” (171). She – I – You cannot leave the house until morning. It is
not permissible for her to leave the
house until morning because it is not appropriate for a woman to wander alone
at night, and it is not appropriate for a severely ill psychiatric patient to
leave her place of care without apparent reason. This nocturnal waiting makes
apparent the narrator’s social confines. Here, as in Charlotte Perkins Gilman’s
infamous story about madness, “The Yellow Wallpaper,” the house acts
metaphorically, representing both the long history of female domestic
confinement and the confinement of the mentally ill in asylums. In the morning
– when it is allowed – she will emerge. Her actions are governed by what
Wendell calls “cultural authority,” which strips the individual of a narrative
deviating from ‘proper’ cultural representation (243).

This cultural
confinement, ultimately resulting in her inability to decide a course of action
for herself, may also be the reason why Hornbacher’s use of“I” is weakened in this passage. In
contrast to her earlier, extremely decisive claim – “I chose an eating
disorder” (6) –, the “I” in this passage in the memoir is paired with sedentary
verbs. Whereas the first “I” “chose,” “think[s],” “believe[s],” and “sought”
(6-7), this “I” can only “sit” and “hold.” It is only in waiting – in the “four
hours till morning” (172) that the narrator “think[s]” (172). Confined, this
“I” waits for morning by engaging in one of the few activities lying within the
conventional cultural narrative of the female body – that of exercising.
Confined, “I” thereby further confines her body to cultural standards. Her
exercises are done on a chair; even they are sedentary. As “I” follows these
cultural prescriptions, “I” bows to the intertwined – and insistently
“disabling” scripts written both for mental illness and the feminine gender.

In highlighting
the cultural constructions that gave rise to and defined her behaviors,
Hornbacher’s memoir contributes to the critique, offered by disabilities
studies, of the medical construction of illness. And yet Hornbacher also
describes her narrator’s behavior in clinical language, thereby reinforcing the
medical framework she critiques elsewhere in the same passage. In doing so, she
is also contributing to the field of the medical humanities by using, in
Edwards’ terms, language to describe her experience with illness in a way that
the medical community can understand (241). By juxtaposing the cultural
constructions of her illness within clinical language, Hornbacher exemplifies
one way that medicine might incorporate broader causes for illness into its
diagnostic framework.

In the space of a
few sentences, Hornbacher triangulates three distinct theoretical lenses.She embraces a diagnostic framework
while refusing its constriction. She identifies several selves within one
narrator and feminizes each self in the process, while constructing a
distinction between this “I-you-she” and the “crazy” woman with the shopping
cart. Hornbacher straddles the line between individual and collective
experience, using a feminized “you” to draw her reader into a collective
experience of disabled and confined femininity. She draws eating-disordered
individuals together into a discrete diagnostic category, and she draw disabled
persons into a collective social constriction.

Yet, by virtue of
the personal details she uses to construct this genre, Hornbacher also
emphasizes her experience as individualistic. A singular individual sits in a
specific house, waiting for specific people to stop shuffling. A singular
individual waits “four hours till morning” (172). Such details define her work
as memoir in the traditional masculine sense while her narrative multiplicity
resists the traditional masculinized form of her chosen genre.

And yet the
identity of her main character remains ambiguous as the memoir draws to a
close. In the final sections, Hornbacher describes her “limbo period after
leaving the hospital the last time” –

I was grasping at straws. . . If
you do that long enough, you eventually get a hold of some, enough, anyway, to
keep going. I no longer had anything that I understood or could believe in. The
situation I was in then is not at all uncommon. The experts say, What did you
do before your eating disorder? What
were you like before? And you simply stare at them because you can remember no
before, and the word you means
nothing at all. Are you referring to Marya, the constellation of suicidal
symptoms? Marya, the invalid? Marya, the patient, the subject, the case study,
the taker of pills, the nibbler of muffins, the asexual, the encyclopedia, the
pencil sketch of the human skeleton, the bearer of nightmares of hunger, the
hunger itself? (279).

In this late passage, Hornbacher
unmasks her convention of pronominal switching, revealing it as an attempt to
negotiate fractured, often antithetical identities. To use a clinical term,
Hornbacher’s narrator is dis-integrated (Gasker 8). She exists as several
identities – some assigned to her by her disease and by medical professionals,
others developed in an attempt to relate her experience in an understandable
way – and the close of her narrative makes it clear that the entirety of her
work is the product of these interrelated selves. Hornbacher here uses her own
first name, Marya, not to mark one discrete identity, but rather as the label
that unifies all of her identities. Hornbacher’s first name has no single
referent, its repeated evocation functioning rather as evidence that her
identity can no longer be referred to in the singular. The experts ask “you”
what “you” were “like before” (279), but the narrator, struggling to find a
coherent identity, can only reference a cluster of behaviors, abstract terms
(‘hunger”), and medical terminologies. Amidst these complexities, the “you”
fails to become an “I.”

This
complex construction follows a single-sentence paragraph which asserts that
“[t]here is, in fact, and incredible freedom in having nothing left to lose”
(2790. That line constitutes a declarative pseudo-philosophical statement,
lacking all personal identification. The following paragraph betrays the
unsteady ground on which the narrator stands by testifying to the singular
experience of her often transient “I.” The “I’ has just left the hospital. The
“I” is disoriented and “grasping at straws” (279). The “I” uses unsure words –
“limbo,” “grasping,” a negated “believe” (279). “I” attempts to normalize her
situation –“The situation I was
in then is not at all uncommon” (279) – as a way of showing that her pronominal
identity cannot stand by itself. Almost immediately, the “I” is traded for an
empathetic “you,” which functions both to eradicate the personal details from
the prose and to place the reader in the place of the narrator. The “you” handles
the “I’s” uneasiness, as it is “you” who “get[s] a hold of some [straws] . . .
to keep going” (279). In switching from the personal “I” to “you,” Hornbacher
clearly blurs the blurs the boundaries between the “normal” and the disabled.
In fitting “you” so easily into this situation that is “not at all uncommon”
(279), Hornbacher makes “you” as disabled as “I” is.

The pronoun “you”
fulfills a strong function as both a normalizing and empathetic vehicle. But Hornbacher
then places “you” in a state of uneasiness similar to that of “I.” Instead of
deliberately projecting “you” onto the reader, and so forcing “you” to
participate in the activities described in the text, Hornbacher incorporates
the pronoun into the direct address of medical professionals who now enter the
paragraph and draw the “you” into a medicalized, therapeutic situation. If “I”
is subject to the uncertainty of external forces, “you” is subject to the
uncertainty experienced by patients imbricated in medical discourse. Edwards
argues that traditional medicalized discourse disallows effective communication
between medical professionals and their patients (241). Such ineffectiveness is
certainly apparent in this passage when professionals ask “you’ what “you” did
“before your eating disorder,” (279) and “you,” flummoxed by her awareness of
multiple selves, can only stare back because “the word you means nothing at all” (279).

Applied to
herself, “you” no longer has any meaning for the narrator. So she “aims” the
pronoun “back at” the medical professionals who are questioning her, shifting
its referent from the narrator to the medical community: “Are you referring to
Marya, the constellation of suicidal symptoms?” (279). Does this shift thereby
project the identity assigned to her by the medical community unto the medical
professionals themselves? If “you” means “nothing at all” (279), “you” can be
anyone – or no one.

By so closely
juxtaposing her normalized, empathetic “you” with a “you” applied to the
medical practitioners, Hornbacher refuses the identities ascribed to her
throughout treatment by ascribing them to her medical caretakers. “How do you
understand yourself in the context of these
labels?” she seems to ask.In her
conflation of two ascriptions of “you,” Hornbacher forces medicalized
identities back onto the professionals who assigned them, and so reflects
common professional misunderstanding of her all-too-common condition. By
responding to the medical professionals with a rhetorical question employing
“you,” Hornbacher re-casts their question, “What did you do before your eating disorder?” (279), as ludicrous.

In these multiple
ascriptions, the ever-shifting and illusive referent “you” answers the
political challenge of women’s life writing, as Buss described it (97).Here the referent for “you” is
uncertain – it means nothing, or it means everything, as Hornbacher applies it
to various people in turn. The “you” as the narrator, then the reader, then
again the medical professional, is variously directed back by each of these in
turn. The reader may choose to empathize with “you,” while the medical
professionals ascribe various identities to “you.” In this shift of referents,
“you” represents the disabling effects of a culture that limits the gendered
body by subjecting it to external forces – most notable, the medical
interpretation and treatment of a distinctly feminized illness.

Near
the end of this passage, Hornbacher refers to “Marya” as a third-person
singular character whose identity never settles on any one of the terms applied
to her by the medical community. After the “I” emerges from the hospital, after
the “you” displays confusion, after all the clinical evaluations and labels,
the name of the narrator means little in relation to the various social
constructions of her illness. Through illness and treatment, the narrator has
lost any sense of a coherent self.

The
final pages of Horbacher’s memoir offer no resolution to the dis-integration
that she has so minutely described. The narrator is at turns dismissive
(declaring that “[w]anting to be healthy is seen as really weird” (283)), “healed” (“You fix yourself. It is the
hardest thing I have ever done” (284)), and unsure (the section entitled
“Present Day” recounts the still very active struggle she has with Anorexia
Nervosa). In the context of such a tumultuous disease, the narrator’s identity
has become dis-integrated. The many selves that lie within the individual can
no longer be described in a narrative with a multi-faceted, yet unified
narrator.Because she lacks coherence,
the narrator offers the projective surface of the female body, on which western
medicine and culture both play out conventional power dynamics. Both medicine
and culture vie to be the source of unification for the dis-integrated
narrator. Medicine provides a story of diagnosis and treatment; culture, a
story of expectations for gender performativity. In both of these narrative
frameworks, the dis-integrated individual is stripped of the ability to
negotiate her own coherent self.

Hornbacher ends
her memoir with a testimony to her loss of agency: “And then it [my heart]
tumbles into sleep, grabbing me by the hair and pulling me down into these
watery sleeps that are so terribly deep and cold” (289). In the end, it is this
larger medical discourse – the one that has literally defined the workings of
her body, the one that has told her that her hearts beats are irregular – that
maintains control over “me.”

IV. Women’s Life Writing,
Extended

Marya
Hornbacher’s memoir closes with a six-page bibliography of “book-length texts”
(291), which excludes many other sources: “the articles in scholarly, medical,
and psychiatric journals consulted . . . would be too numerous to cite” (291).
The presence of such an extensive body of research, as well as various citations
and footnotes throughout her text, situated Hornbacher’s memoir within a large
body of clinical literature. In its attention to the narrator’s social and
political climate, the text also challenges the boundaries of clinical
literature, extending the scope of that genre by drawing on the resources of
the tradition of women’s life writing. In her introduction, Hornbacher
describes that the narrative that follows as is stereotypical of
eating-disordered patients: “female, white young, middle-class” (7). By
creating a narrative belonging to “the stereotype,” Hornbacher casts her text
as a case study. By reading her memoir as a case study, we can come to
understand, in clinical terms, how an eating disorder might manifest itself in
an individual life.

And
yet immediately after she claims that her story is “stereotypical” – and so
perfectly exemplary of a documented disorder – Hornbacher resists the confines
of the clinical structure within which she presents herself: “I wrote this
because I object to the homogenizing, the inaccurate trend in the majority of
eating disorders literature that tends to generalize the part from the whole”
(7). Instead, Hornbacher explains, she will present her disorder as “an attempt
to find an identity” (6). Hornbacher’s introduction thus sets up her narrative
as a negotiation between genres. She works within the genre of the clinical
case study, personalizing it, extending it to a larger audience, and adding the
political and sociocultural realms that such studies generally eschew; she does
so by interweaving clinical “objectivity” with subjective techniques drawn from
the literary genre of memoir.

Hornbacher’s
text exemplifies the “rhetoric of uncertainty” which Heilbrun describes as
central to autobiography; it does so by moving from introspection “outward”
(18, 24). Benstock identifies this “outward” gesture as the embrace of personal
experience by a larger population (8); women’s autobiography, according to her
description, encapsulates not only the self but the political collective of
which the self is a part. It is this move that, I argue, Hornbacher
accomplishes.

Hornbacher
capitalizes on the multiplicity inherent in this interpretation of the
tradition of women’s life writing by using multiple pronouns throughout her text.
“I”, or the self specific to the narrator who owns the details of her
particular life, goes to her aunt and uncle’s house for a meal of French bread
and spaghetti (175). This “I” specifically remembers buttering that French
bread and then throwing it up later in the evening, before she sleeps on her
mother’s lap (175). “You” and “we,” in contrast, are used to mark “ownership”
of nonspecific details applicable to a larger community. “We” refers to
patients who are eating disordered: “we” have “assertiveness groups”and “nutrition classes” (155), “we” are
“[a]noretics [with] strange shopping lists” (237). By and large, “we”
represents a collective outside of the presumed normal; it is often through
“we” that the “I” projects a singular experience, thus multiplying and
depersonalizing it. “You” is often broader than “we”: “you” forces every reader
to occupy the place of “I.” Chapter 4 of Wasted, for example, opens with eight pages in which the only pronoun is
“you.” In these pages, “you” are taken through a hospital stay, given slippers,
figure out which nurses to dislike, and are stripped of “forbidden things . . .
[r]azors, matches, cigarettes” (145, 149). Telling the reader what is happening
to “you” extends the clinical experience beyond both that of the singular “I”
and of the collective “we”: it makes the reader to occupy the space of being
disabled.

By
constantly shifting the pronouns in this autobiographical writing, Hornbacher
effectively reframes a singular experience both as clinical and sociopolitical.
By making not just “you” ill, but the entire communal “we” disabled, Hornbacher
redefines eating disorders: rather than only psychiatric problems requiring
medical treatments, she represents them as conditions situated within a
cultural context that propagates their development and prolongation. Wendell
argues that “[p]aradigms of health and ideas about appropriate kinds and levels
of performance are culturally dependent” (245). Because society is organized
around normative behavior, it treats difference as a problem requiring
alteration. As McDermott and Varenne show, the structure of ability we call
“culture” thus both creates and maintains disability; Hornbacher’s pronominal
use highlights this debilitating consequence of the construction of the normative.
By applying disability first to “you,” then marking it powerful enough to
create a communal “we,” Hornbacher’s prose makes the constructed-ness of
disability transparent by refusing any pronominal divide between the normative
and the disabled, between the experience of the patient and of the “well.”

In refusing
divides between herself, her audience, and a larger community by employing
varied pronouns, Hornbacher, in addition to telling the story of her own
multiple selves, creates a cultural narrative that also negotiates the
challenge of stability versus multiplicity. Buss explains that the challenge of
the female autobiographer is presenting a decentered, multiplied self as
unified in the context of external, dominating forces.Hornbacher’s “I” situates the author’s
multiplied individual self within a coherent narrative, drawing on stable
personal details of her one, specific life to unify the chaos brought by the
cultural interpretations of her feminized body and illness. Thus, the “I” shows
Hornbacher’s individual negotiation of the challenge of women’s life writing.

Extending this
negotiation is Hornbacher’s remaining pronouns, which work to break the divide
between the pathology of the individual and that of society. In extending her
individual pathology to “you,” “we,” “her,” and “them,” Hornbacher exemplifies
a way in which women’s life writing becomes less individual and more
collective. All of her pronouns are collected under the same cultural forces,
and all are interrelated, switching referents as Hornbacher uses them
interchangeably, to highlight the multiplicity of all individuals within
society.Hornbacher thus not only
tells her own story in a unified, multiplied way, but she also tells a larger
cultural story of stability in the presence of multiplicity by eliminating the
boundary between individual and collective pathology. Hornbacher’s pronominal
switching then highlights an expanded negotiation of Buss’s dilemma and brings
a greater emphasis on society at large to the genre of women’s autobiographical
writing.

By reframing the
clinical experience as sociopolitical and by doing so in the context of the
memoiric genre and shifting pronouns, Hornbacher reframes the scope of women’s
life writing, extending what once historically focused on the masculinized,
individualized, unified autobiographical self to a collective societal
narrative that focuses on the stability and multiplicity of us all.

Friday, April 20, 2012

As Evans et al.
explains in their overview, Medical Humanities: A Practical Introduction, in the 1960s, questions arose about the “underlying
authority of modern scientific medicine” (3), which at the time was grounded in
“biomedicine,” or “the overall trend . . . for the patient narrative gradually
to disappear in favor of technical investigation, for symptoms to give way to
disease entity, and for treatment to become non-negotible” (11). This crisis
was fed by

the emergence of the
anti-psychiatry movement; the inability of science and technology to deal
effectively with many chronic and disabling conditions, despite escalating levels
of public expenditure on healthcare; and an awareness of the personal
insensitivity of much of modern medicine and its failure to take account of the
patient’s perspective (13).

A growing movement toward reform of
medical practice catalyzed the development of the field of medical humanities.

David Greaves
defines the humanities as “subjects concerned with the uniqueness of
individuals rather than generalization” (15). This definition of the
humanities, when taken in a medicalized context, challenges the
depersonalization and institutionalization of diagnosis and begs for a return
to individual narratives. Greaves “equates” the medical humanities “with the
medical arts” (18), to which the practices of science and technology are
subordinated (14). Greaves depicts these medical arts as a counterbalance to
biomedicine, and conceptualizes medical practice as a balance of arts and
science that

focuses on the human as relevant to
the whole of medicine and so cuts across the traditional formulation of western
medicine as comprising separate realms of art and science, with the human
aspects restricted mainly, if not exclusively, to the former (18).

By defying the binary between the
sciences and the arts, the medical arts offer “an innovative and unified approach”
to medicine that reconsiders medical theory and urges “practitioners to develop
a more rounded and humane attitude to their practice” (Greaves 19). Just as
Greaves considers both the macro- and microscopic implications of involving the
humanities in science, I will consider the implications of a reformed medical
narrative on both an individual and societal level in my analysis of
Hornbacher’s text.

Richard Edwards also identifies the
medical humanities as responding to generalized and impersonal theories of
medicine. Edwards points out that evidence-based medicine leads to
generalizations that do not necessarily match the needs or situation of the
individual, and that “even in ideal circumstances,” when the individual does
meet a generalized clinical picture of an illness, “it remains imperative to
address and respond sympathetically to the emotional consequences of diagnosis
and treatment” (238). Medical humanities aims to remedy such problems arising
from clinical generalization.

Edwards
reports a variety of ways the medical humanities works to reform the existing
structure of medicine. First they provide a language for patients to
communicate more effectively with their physicians, allowing them both to
verbalize their emotions concerning diagnosis and treatment and to create
narratives exploring possible courses of action (241). Next, these narratives
and emotional depictions of disease provide frameworks for evidence-based
theory, allowing physicians to reassure patients by exploring the benefits and
drawbacks of a treatment fromboth
theoretical and emotional perspectives. Finally, the medical humanities build
upon “problem-based learning” (245); they beg for a “questioning,” critical
approach that “promote[s] reflective practice and learning” (242). Such a
complete evaluation is conducive to exploring of alternative and complementary
therapies for illness, including treatments not as often empirically validated,
such as those associated with eastern medicine (242). Edwards also argues that
it is useful

to employ published narratives or
artistic representations of ill health as qualitative input alongside actual
patients’ narrative, to widen perspective and facilitate a more sympathetic
understanding of the ‘human condition’ (237).

Published narratives
of illness work, on a grander scale than do oral, unpublished patients’
narratives, to promote change within western medicine. In publishing such
narratives, patients develop a voice apart from medical generalizations,
fitting their personalized medical stories into the existing clinical
literature, thus expanding clinical language beyond objective descriptions of
their conditions. In published personal discourses of illness that combine
clinical and personal narratives, the field of medical humanities is made
visible. It is in such a space that I situate my own analysis of such a
narrative.

B. Disabilities Studies

But
the space created by the medical humanities is not quite large enough for the
work I want to do with Hornbacher’s memoir. When disabilities studies scholar
Margaret Price visited the Bryn Mawr College campus in February, she made a
distinction to several of us over lunch between the fields of medical
humanities and disability studies. While the medical humanities arose from
within medical schools and thus look to reform medicine from the inside,
disabilities studies is the academic branch of a social activist movement that
both models itself on past movements (such as those for civil and women’s
rights) and positions itself uniquely, and primarily, as a critique of the
“medical model” of disability. As Lennard Davis elaborates on this distinction,
disabilities studies is “both an academic field of inquiry and an area of
political activity” that “aims to challenge the received in its most simple
form – the body – and in its most complex form – the construction of the body”
(xv-xvii). Even more broadly, Susan Wendell explains, the field critiques the
belief that “the world [is] structure[d] for people who have no weaknesses”
(243); it posits, instead, that weakness is a socially constructed paradigm,
based upon an unspoken, implicit archetype of the “perfect” body that all
humans strive to achieve.

Only in the past
few decades have disabled individuals begun to organize themselves politically;
a major accomplishment of the Disability Rights movement was the passage of the
Americans with Disabilities Act in 1990 (xvi). Emerging work in disabilities
studies drew both on this social movement and on academic work in feminist
studies, sociology, and philosophy, by scholars such as Jacques Derrida, Judith
Butler, Susan Bordo, Erving Goffman, and David Rothman (Davis xvii). As Davis
explains, the “work of a newer generation of writers and scholars looks toward
feminist, Marxist, postmodern, and cultural studies models for understanding
the relation between the body and power” (xvii).

But this next
generation of writing is also distinct in that it “tends to be created from
within the boundaries of disability” (xvii). It does not attempt to “share” the
disabled experience with normative audiences, but rather shuns the inherently
unequal balance between disabled and able-bodied that occurs when works are
“sensitized” (so as to evoke sympathy from a normative audience) in such a way
(xvii). By upending this power dynamic, disabilities studies scholars avoid the
“advocacy trap” that promotes emotive, sympathetic understanding at the cost of
reinforcing cultural conceptions of disability as weakness and as disadvantage.
It thereby creates room for critical inquiry into difference

Davis explains
that disability has traditionally “been seen as eccentric, therapeutically
oriented, out-of-the-mainstream, and certainly not representative of the human
condition” (xv); it has been treated much in the way that “race, class, and
gender have been theorized” (xvi), placed in a unique sociopolitical cultural
context and understood as a request for special needs. The field of disability
studies constructs a counter-narrative by placing individual difference in
social and political context, and identifying oppression as a social
construction that needs to be de-institutionalized. The field focuses on the
power dynamics between the social norms of ability and individuals unable to
meet those norms, who are thus exposed “to inspection, interrogation,
interpretation, and violation of privacy”; “people with anomalous bodies are
often called upon to account for them, sometimes quite explicitly: they may be
asked, ‘What happened to you?’ ” (Couser
400).

Susan
Wendell points out that the given definitions of “disability” and “handicap”
are dependent on recognition of the normative (245), and that “[p]aradigms of
health and ideas about appropriate kinds of levels of performance are
culturally dependent” (245). The United Nations defines disability as “[a]ny
restriction or lack (resulting from an impairment) of ability to perform an
activity in the manner or within the range considered normal for a human being”
(244). Handicap, which refers to the social disadvantage resulting from disability,
is “the loss or limitation of opportunities to take part in the life of the
community on an equal level with others” (24s4). Thus, social function is
inextricably linked to social constructs, like disability, that allow for
“normative” experiences of society. Wendell explains that because social
conceptions of disability are so dependent on context, “we might eliminate the
category of the ‘disabled’ altogether, and simply talk about individuals’
physical abilities in their social context” (245). Disabilities studies
examines functionality within cultural confines and asks how degrees of
functionality may contribute to a given culture.

This
is the particular focus of Ray McDermott and Herve Varenne, who show how, when
a culture selects certain features, such as academic achievement, that it
values, it disables those who cannot achieve in that arena. For example, the
advent of the radio presumed that the normative, able-to-hear majority would
benefit from receiving information in this manner – and thus excluded those who
were deaf from a new source of news and entertainment. McDermott and Varenne
argue that such social inventions, which enable one portion of the population,
disable others by denying them some degree of social functionality.

According
to other disability studies scholars, the field of medicine is particularly
egregious in this regard. Wendell shows how contemporary medicine “plays into
and conforms to our cultural myth that the body can be controlled” (249).
Doctors are “trained to do something to control the body” (250) – the body must
bend, under various therapies, to the will of the physician, who aims to return
the body to a cultural norm. Wendell labels this the “heroic approach to
medicine” (250), a method in which “[m]edical professionals have been given the
power to describe and validate everyone’s experience of the body” (253).

Feminist
disability theory has been particularly crucial in advancing this argument. As
Rosemarie Garland-Thompson explains, “The fundamental premise of Disability
Studies is that disability is a culturally fabricated narrative of the body, a
system that produces subjects by differentiating and marking bodies” (1). Her
analysis of the field draws together feminist rejection of the cultural
narrative of the female identity and body, with disabilities studies’ rejection
of the narrative of the disabled identity and body:both force us “to realize that other people have more social
authority than you do to describe the experience of your own body” (254).

Combining the two
fields into what she refers to as “feminist disability critical theory,”
Garland-Thompson outlines a methodology for reading the narratives of disabled
women, which draws on these fundamental premises:

that representation structures
reality; that the margins define the center; that gender and disability are
ways of signifying relationships of power; that human identity is multiple and
unstable; and that all analysis and evaluation has political implications. (6)

It is this approach to the disabled
female condition – that society has constructed gender as a disability, and
that a disabling gender and a traditional disability are inseparable when
critically viewing a disabled woman – on which I will draw in my examination of
Hornbacher’s memoir. In my reading of Wasted, I will use disabilities studies as a reflective field that sheds
light on the constructions that either name or cause disability. For the
purposes of my paper, disabilities studies will be a means of explaining eating
disorders outside of the clinical literature. It helps explain how culture is
constructed in such a way as to facilitate the development of these disorders,
and to explore how society might cope with these disorders in non-clinical
ways.

Disabilities
studies has a particularly useful relation to theories of autobiography and
representation. As Couser explains, the “cultural representation of disability
has functioned at the expense of disabled people, in part because they have
rarely controlled their own images” (399). In contrast to these historic
practices, disabled people have more recently “initiated and controlled their
own narratives” (399). This writing, Couser suggests, should be considered a
“retort” to “misrepresentation of disability”: the writing resists the cultural
narratives that are “inscribed” on the bodies of the disabled (400). Margaret
Price illustrates Couser’s idea by describing the ways in which, by showing a
multiplicity of selves through the deliberate confusion of a narrative “I,”
autobiographical writing by disabled individuals creates a culture of
counter-diagnosis that defies the framework contributing to the
institutionalization and oppression of individual difference.

Integrated with
cultural and personal narratives of disability and gender, and challenging of
traditional medical structures, disabilities studies contributes some key
insights to my interpretation of Hornbacher’s representation of eating
disorders, which stretch beyond the clinical and the personal. I use
disabilities studies as a lens that expands medical humanities to include the
sociopolitical and cultural aspects of illness. Trained on the genre of women’s
autobiographical writing, both fields enable me to show how medicalized
narratives might be expanded to consider a larger range of diagnostic
implications.

C. Women’s Life Writing

Theorists
of feminist autobiography include various nonfictional forms –memoir, letters, diaries, and
autobiography – in the overarching genre of life writing (Smith and Watson).
The subtitle of Wasted: A Memoir of Anorexia and Bulimia deliberately situates Hornbacher’s work within the
genre of women’s life writing. Women’s life writing is derived from the male
autobiographical tradition, which stresses “the defense and glorification of a
man, career, a political cause, or a skillful strategy” (Benstock 8). For many
centuries, female autobiography reflected a reinforcement of the “token woman”
– the inevitable response to the “masculine man” as presented in male
autobiography –(Heilbrun 16) and
a continuation of the “one plot” available to women, which ended either in
marriage or death (17). Women’s autobiography was traditionally “sentimental
and passive” (19), bringing out only the expected behaviors for the public to
see, while keeping private all messier goals, hopes, and angers.

The
tradition of women’s life writing, however, developed another stream – that of
confessional writing, which, with its emotive and tell-all nature, defied the
conventional male literary script within which women’s autobiography operated.
Writing confessions enabled women to express their “uninhibited
autobiographical impulses” (23). Such writing created a “rhetoric of
uncertainty” (18) that today often characterizes women’s life writing. Unlike
male autobiographical writing, women’s life writing “has become an exploration
of painful experience rather than denial of pain and struggle” (25), moving
outward from introspection and extending their experience to a larger
population (Heilbrun 24, Benstock 8).

In
its defiance of the masculine autobiographical tradition, feminist scholars see
women’s life writing as inherently politicized. The act of confession, of
making the private public, turned women’s autobiography into feminist discourse
by integrating the political and the personal dimensions of life writing.
According to Estelle Jelinek, women’s “self-portraits” have long been
distinguished from men’s by their “irregularity rather than orderliness” (17),
which has expanded to include writing that seems like “a jungle of fragments”:
truncated sentences without proper subjects, perhaps consisting only of a
phrase, or even a single word, resembling “the kind of shorthand writing
characteristic of diaries and notebooks,” and perhaps interrupted by passages
that are “chronological, progressive, and strictly grammatical” (171). These
stylistic trends of women’s life writing, Jelinek argues, politicize female
texts. Other stylistic choices, including the multiplicity of the singular
subject, which Benstock places in direct contrast to the male resistance of the
“discordant ‘I’ ” (8), indicate that women have developed means of representing
their coherent, fractured, and multiplied selves outside of the traditional
prescriptive male forms.

Yet,
Helen Buss argues, because the autobiographical tradition still begs for the
singular self as subject, the female autobiographer faces a unique challenge:
experiencing herself as “fragmented, decentered, and dominated by forces
largely beyond her control,” while nonetheless presenting her autobiographical
self in a “stable, unified” way (97). Buss calls this the “doubled discourse”
of women’s life writing (97). Women must strive to satisfy the demands of the
genre while faithfully representing their politicized bodies and identities.
The fragmentation in women’s life writing, then, reflects the feminine
politicized self, acknowledging a history of oppression and disabling cultural
forces while speaking for both the unified “I” and a larger female majority.

I here consider Hornbacher’s
memoir as an example of this kind of complexly negotiated women’s life writing,
and will evaluate it within this history, as an example and possible extension
of agenre with a long historical
lineage. The tradition of women’s life writing represents the theoretical
capstone to my three areas of interest, as I will use it to explain how
Hornbacher’s text ultimately represents an expanded form of clinical
literature.

III. Explaining Pronomial Use in
Wasted

In
Wasted: A Memoir of Anorexia and Bulimia,
Marya Hornbacher claims that she is committing “cultural heresy” (5). Through
her analysis both of her eating disorder and what it takes to recover, she
violates long-standing ideas about femininity and wellness in order to embrace
a clinical picture of her disorder that encourages her to say, “I will eat what
I want and look as I please and laugh as loud as I like and use the wrong fork
and lick my knife” (5). Much of what Hornbacher accomplishes in this clinical
depiction of herself as an eating-disordered patient, and her rejection of
cultural standards in favor of biological health, stems from her
interchangeable usage of first-, second-, and third-person voices, which aim to
shed light on the texture of eating disorders as both mental illness and cultural
phenomenon. The memoir never settles on a distinct pronominal “I.” Rather, the
text speaks to “you”, the reader(s); to “her” or “them,” the eating-disordered
individual(s); to “us” or “we,” the eating-disordered collective or community.
“I,” the ostensible bearer of the narrative, seems to surface only when
particular details of the life in question are too specific to be attributed to
“you,” “her,” “them,” “we” or “us.”

I
will examine a few exemplarypassages in which this pronominal switching is particularly
important and apparent, although Hornbacher employs the technique regularly
throughout the memoir, following a fairly consistent pattern.

The
first passage I want to discuss occurs early in the memoir, in the
introduction, and so functions as evidence of how quickly Hornbacher delves
into this unique pronominal usage. Hornbacher begins her first description of
the cognitions and cultural influences behind eating disorders in
second-person, thereby both tagging us readers as eating-disordered, and
telling us what we think about “our” shared condition. An eating disorder, she
explains,

is . . . an attempt to find an
identity, but ultimately strips you of any sense of yourself, save the sorry
identity of “sick.” It is a grotesque mockery of cultural standards of beauty
that wind up mocking no one more than you. It is a protest against cultural
stereotypes of women that in the end makes you seem the weakest, the most needy
and neurotic of all women. It is the thing you believe is keeping you safe,
alive, contained . . . An eating disorder is in many ways a rather logical
elaboration on a cultural idea. While the personality of an eating-disordered
person plays a huge role – we are often extreme people, highly competitive,
incredibly self-critical, driven, perfectionistic, tending toward excess - . .
. I do believe that the cultural environment is an equal . . . culprit in the
sheer popularity of eating disorders. .
.I chose an eating disorder. I
cannot help but think that, had I lived in a culture where “thinness” was not
regarded as a strange state of grace, I might have sought out another means of
attaining that grace, perhaps one that would not have so seriously damaged my
body, and so radically distorted my sense of who I am (6-7).

By page six, Hornbacher conflates
herself, an eating-disordered individual as “you,” with a layered narrative
identity. Her claim that the consequences of her eating disorder “radically
distorted my sense of who I am” (7) create the space for her to oscillate between
narrative identities, allowing her to become, by turns, the patient, the
feminist, and the pedestrian onlooker all working against containment within
one memoric self.

Traditionally,
non-feminized forms of autobiography and its subgenre, memoir, contain the life
narratives of a singular person. By using multiple pronouns to tell her
narrative, Hornbacher challenges this traditional masculine sense of memoir,
embracing instead what Jelinek describes as the tradition of presenting “a
multiplicity of selves” within a feminine autobiographical text. Hornbacher
extends her experience to the reader by demanding that “you” emotionally
empathize with the consequences of distorted eating-disordered cognitions,
which in this passage are cast as general thoughts characteristic of all
eating-disordered patients. Hornbacher does not write, “I felt safe in my
eating disorder;” she asserts instead that “you” are “safe,” “alive,” and
“contained” (6), thereby forcing her audience to emotionally identify with her
experience. Hornbacher thereby creates an emotionally shared narrative, thus
including multiple identities – her own and those of her readers – into her
work in an act that makes explicit the multiplicity of identities that
characterizes women’s life writing.

Hornbacher’s
“you” extends the “disabling” cognitions of having an eating disorder to
the“non-disabled” majority. “You”
is used empathetically, forcing readers to share the experiences of an
eating-disordered individual, to explore the cognitions and the unarticulated
emotions that come with those cognitions. It is not Hornbacher or a woman in
inpatient treatment who seems the “most weakest” (6) – it is “you.” The reader
is forced to become an anoretic, to adopt the “sorry identity of ‘sick’ ” (6).
Hornbacher links this explicit demand that the reader empathize with – if not
actually become – eating-disordered, with a brief mention of the “cultural
standards of beauty” (6) that reinforce eating-disordered behavior. In doing
so, she builds on what McDermott and Varenne argue in “Culture as Disability,”
that culture constructs disability to show that both “you” and “I” experience
social disability in the same way.

Although
Hornbacher uses the pronouns “you” to force her readers into occupying the
space of disability with her, she turns to “we” in the same passage, and
thereby pushes us away, inviting “you” to become a voyeur of “our” competitive
perfectionism. Throughout her memoir, she draws the picture of an
eating-disordered community – in her words, a group of “extreme people” (6)
whose intensity not only feeds into their athletic, creative, occupational, and
academic lives, but into honing their eating disorder. Amy Neeren, my
psychology professor at Haverford College, told me that, in her clinical practice,
she sees a tendency of eating-disordered individuals to compete with each other
to “perfect” their disorders. They want to have the “best” eating disorders.
They want to be the thinnest, eat the least, and, most notably, they want to
exclude others who do not possess like disordered behaviors and cognitions. As
Hornbacher implies when her pronouns shift from “you” to “we”, outsiders do not
combine self-starvation or purgation with self-criticism and perfectionism.
Outsiders do not attain “grace” (7) in the difficult-to-maintain
self-destruction of “true” eating-disordered individuals. In beginning this
passage with the pronoun “you,” Hornbacher signals that we readers are affected
by the disabling cultural ideals that catalyze disordered eating. But in shifting
quickly to “we,” Hornbacher breaks down the empathetic connections she’s just
built with her readers, excluding “us” from her elite, discrete community. She
thus isolates eating disorders as an abnormal response to the collective
culture in which “you all” live. “You” do not have the personality, the family
climate, the sheer drive needed to maintain eating disorders. “You” are invited
to behold “we,” but clearly do not participate in “our” thoughts and behaviors.

As
the passage continues, Hornbacher continues to narrow the experiential
component of her narrative, switching next from first person plural to first
person singular voice, lighting momentarily on “I” to describe her own
particular experience. The use of “I” denotes the kind of agency that,
clinically, is not supposed to be present in the development of an eating
disorder. By stating, “I chose an eating disorder” (6), Hornbacher explicitly
claims that she made an active choice, as if she had surveyed the field of
clinically disordered behaviors from which she could choose and found an eating
disorder to be the most suitable. Hornbacher reports that she experimented with
a plethora of behaviors in her adolescent years (including but not limited to
promiscuity, illicit drug use, and self-mutilating behaviors), so it is
possible that she actively rejected such activities in favor of an eating
disorder. But, given the clinical evidence Hornbacher presents about
eating-disordered “personalities” – that they are “highly competitive,
incredibly self-critical, driven, perfectionistic, tending toward excess” (6) –
it is unlikely that a personality so specifically predisposed could actually be
said to “choose” to be eating-disordered. A clinical view of Hornbacher’s “I” –
with its explicit claim of an agential self –represents the delusional sense of
control associated with eating disorders. Noting an “I” arguably prone to
delusional beliefs and Hornbacher’s follow-up statement that her eating
disorder “radically distorted my sense of who I am” (7), a reader trained in
clinical psychology would interpret the effects of her “rather logical
elaboration on a cultural idea” (6) as pathological. But a disabilities studies
scholar would highlight instead the causal relationship between the culture in
which “you” live, which disables the “I.” “You” is thus both distinguished from
“we,” and yet linked to the “I” that is part of “us.” By connecting her
pronouns circularly in this way, Hornbacher encourages a less medicalized, more
socially determined understanding of eating disorders.

The nature of
Hornbacher’s “I” shifts, however, as the memoir continues. No longer decisive
and forceful, “I” becomes fitful and visceral in its actions, a catalogue of
the more mundane moments of the life the memoir is chronicling. This is the “I”
that dominates the majority of the memoir.

In a much later
passage in which this less decisive “I” appears, Hornbacher again uses pronouns
interchangeably yet skillfully, to slightly different effects:

You go insane about now. You understand, it just
happens. Crazy isn’t always what they say it is. It’s not always the old woman
wearing sneakers and a skirt and a scarf, wandering around with a shopping
cart, hollering at no one, nothing, tumbling through years in her head . . .
No. Sometimes it is a girl wearing boots and jeans and a sweater, arms crossed
in front of her, shivering, wandering through the streets at night, all night,
murmuring to no one, nothing, tumbling through the strange unreal dimensions in
her head. . . Bedtime, and the house falls darker still. I sit at the window,
waiting for the mutterings and shufflings to slow and stop. . . I hold the back
of the chair with one hand, do exercises endlessly, waiting for one o’clock.
Only four hours till morning, I think. (171-172).

Hornbacher here
again fragments her narrative self – she is first “you,” then “she,” finally
again “I.” But all three of the pronouns she uses to describe herself are
clearly differentiated from another “crazy”-appearing group, which includes the
old woman with a shopping cart. By first distinguishing aspects of herself from
one another but then posing them collectively as distinct from another group of
behaviors, Hornbacher finds a subtle, complex pronominal way of negotiating the
dilemma articulated by Buss: that the female memoirist must present herself as
stable and unified while acknowledging herself as “fragmented [and] decentered”
(97).

Hornbacher creates
a boundary between the narrator (whom she refers to variously as “you,” “she”
and “I”) and the woman with the shopping cart, as well as other characters in
the book by means of a distanced perspective on the latter. The narrator has no
apparent insight as to why the woman with the shopping cart is “hollering” or
what she thinks as she “tumbles through the years in her head” (171). The
narrator does not empathize with this “crazy” woman. Because the narrator has
no insight into the experience of the woman with the shopping cart and like
characters, there is distance between the pronouns of Hornbacher’s narrator and
this “crazy”-appearing group, thus helping to stabilize the narrator as a
coherent identity that can be separated from others.

Buss’ ascribes the
dilemma of the female memoirist to all women, whether able-bodied or not.
Hornbacher’s memoir answers Buss’s challenge, in part by complicating it with
her illness; eating disorders give a very particular “turn” to the female
memoirist’s dilemma. Couser explains that autobiographical texts about illness
may be written as a “retort” to the “misrepresentation of disability” (400).
Hornbacher makes this retort explicit when she redefines “crazy” as something
other than the conventional conception: not “always the old woman . . .
hollering. . . tumbling. . .” (171), it may well be exemplified by the ‘normal’-looking
girl who defies the social depiction of mental disability. In casting herself
as “crazy,” Hornbacher attempts to shatter preconceived notions about the face
of mental illness.

By starting the
passage with “you,” Hornbacher resists all conventional social constructions
distinguishing the crazy from the sane, those who are eating disordered from
those who are not. Mental illness, Hornbacher implies, can develop in a
‘normal’ girl in a sweater: as it enveloped the “I,” so can it emerge in “you.”

Using these three
pronouns, first identifying them as discrete from one another then intertwining
them in contrast to an “other,” Hornbacher contributes to what Margaret Prices
calls a “counter-diagnostic” culture (243). She not only challenges conventional
representations of her own mental illness, but also the social framework in
which such representations occupy a particular role. By stating that “crazy” is
not only the woman with the shopping cart, Hornbacher calls into question our
contemporary diagnostic culture, which only recognizes insanity within a narrow
range of abnormal behaviors, specifically, those outlined by the Diagnostic
and Statistical Manual of Mental Disorders.
Insanity, Hornbacher’s text implies, is hard to recognize: it encompasses
behaviors not necessarily stereotyped as indicative of disorder.

Hornbacher’s
pronominal plurality both solves the conventional female autobiographical
dilemma and rebuffs the cultural construction of mental illness. Her complex
use of pronouns extends the concerns of clinical diagnosis to include the
political dilemmas of gender. Since “she” refers to a “girl wearing boots and
jeans and a sweater” (171), and since “she” is connected both to “you” and “I,”
all three pronouns are implicitly feminized. Hornbacher thereby makes it clear
that she is exploring the impact of mental disability, especially the most
feminized of all mental illnesses on a female subject.

Hornbacher writes
that she “sit[s] at the window, waiting for the mutterings and shufflings to slow
and stop” (171). She – I – You cannot leave the house until morning. It is not permissible for her to leave the house until morning because it
is not appropriate for a woman to wander alone at night, and it is not
appropriate for a severely ill psychiatric patient to leave her place of care
without apparent reason. This nocturnal waiting makes apparent the narrator’s
social confines. Here, as in Charlotte Perkins Gilman’s infamous story about
madness, “The Yellow Wallpaper,” the house acts metaphorically, representing
both the long history of female domestic confinement and the confinement of the
mentally ill in asylums. In the morning – when it is allowed – she will emerge.
Her actions are governed by what Wendell calls “cultural authority,” which strips
the individual of a narrative deviating from ‘proper’ cultural representation
(243).

This cultural
confinement, ultimately resulting in her inability to decide a course of action
for herself, may also be the reason why Hornbacher’s use of“I” is weakened in this passage. In
contrast to her earlier, extremely decisive claim – “I chose an eating
disorder” (6) –, the “I” in this passage in the memoir is paired with sedentary
verbs. Whereas the first “I” “chose,” “think[s],” “believe[s],” and “sought” (6-7),
this “I” can only “sit” and “hold.” It is only in waiting – in the “four hours
till morning” (172) that the narrator “think[s]” (172). Confined, this “I”
waits for morning by engaging in one of the few activities lying within the
conventional cultural narrative of the female body – that of exercising.
Confined, “I” thereby further confines her body to cultural standards. Her
exercises are done on a chair; even they are sedentary. As “I” follows these
cultural prescriptions, “I” bows to the intertwined – and insistently
“disabling” scripts written both for mental illness and the feminine gender.

In highlighting
the cultural constructions that gave rise to and defined her behaviors,
Hornbacher’s memoir contributes to the critique, offered by disabilities studies,
of the medical construction of illness. And yet Hornbacher also describes her
narrator’s behavior in clinical language, thereby reinforcing the medical
framework she critiques elsewhere in the same passage. In doing so, she is also
contributing to the field of the medical humanities by using, in Edwards’
terms, language to describer her experience with illness in a way that the
medical community can understand (241). By juxtaposing the cultural
constructions of her illness within clinical language, Hornbacher exemplifies
one way that medicine might incorporate broader causes for illness into its
diagnostic framework.

In the space of a
few sentences, Hornbacher triangulates three distinct theoretical lenses.She embraces a diagnostic framework
while refusing its constriction. She identifies several selves within one
narrator and feminizes each self in the process, while constructing a
distinction between this “I-you-she” and the “crazy” woman with the shopping
cart. Hornbacher straddles the line between individual and collective
experience, using a feminized “you” to draw her reader into a collective
experience of disabled and confined femininity. She draws eating-disordered
individuals together into a discrete diagnostic category, and she draw disabled
persons into a collective social constriction.

Yet, by virtue of
the personal details she uses to construct this genre, Hornbacher also
emphasizes her experience as individualistic. A singular individual sits in a
specific house, waiting for specific people to stop shuffling. A singular
individual waits “four hours till morning” (172). Such details define her work
as memoir in the traditional masculine sense while her narrative multiplicity
resists the traditional masculinized form of her chosen genre.

And yet the
identity of her main character remains ambiguous as the memoir draws to a
close. In the final sections, Hornbacher describes her “limbo period after
leaving the hospital the last time” –

I was grasping at straws. . . If
you do that long enough, you eventually get a hold of some, enough, anyway, to
keep going. I no longer had anything that I understood or could believe in. The
situation I was in then is not at all uncommon. The experts say, What did you
do before your eating disorder? What
were you like before? And you simply stare at them because you can remember no
before, and the word you means
nothing at all. Are you referring to Marya, the constellation of suicidal
symptoms? Marya, the invalid? Marya, the patient, the subject, the case study,
the taker of pills, the nibbler of muffins, the asexual, the encyclopedia, the
pencil sketch of the human skeleton, the bearer of nightmares of hunger, the
hunger itself? (279).

In this late passage, Hornbacher
unmasks her convention of pronominal switching, revealing it as an attempt to
negotiate fractured, often antithetical identities. To use a clinical term,
Hornbacher’s narrator is dis-integrated (Gasker 8). She exists as several
identities – some assigned to her by her disease and by medical professionals,
others developed in an attempt to relate her experience in an understandable
way – and the close of her narrative makes it clear that the entirety of her
work is the product of these interrelated selves. Hornbacher here uses her own
first name, Marya, not to mark one discrete identity, but rather as the label
that unifies all of her identities. Hornbacher’s first name has no single
referent, its repeated evocation functioning rather as evidence that her
identity can no longer be referred to in the singular. The experts ask “you”
what “you” were “like before” (279), but the narrator, struggling to find a
coherent identity, can only reference a cluster of behaviors, abstract terms
(‘hunger”), and medical terminologies. Amidst these complexities, the “you”
fails to become an “I.”

This
complex construction follows a single-sentence paragraph which asserts that
“[t]here is, in fact, and incredible freedom in having nothing left to lose”
(2790. That line constitutes a declarative pseudo-philosophical statement,
lacking all personal identification. The following paragraph betrays the
unsteady ground on which the narrator stands by testifying to the singular
experience of her often transient “I.” The “I’ has just left the hospital. The
“I” is disoriented and “grasping at straws” (279). The “I” uses unsure words –
“limbo,” “grasping,” a negated “believe” (279). “I” attempts to normalize her
situation –“The situation I was
in then is not at all uncommon” (279) – as a way of showing that her pronominal
identity cannot stand by itself. Almost immediately, the “I” is traded for an
empathetic “you,” which functions both to eradicate the personal details from
the prose and to place the reader in the place of the narrator. The “you”
handles the “I’s” uneasiness, as it is “you” who “get[s] a hold of some
[straws] . . . to keep going” (279). In switching from the personal “I” to
“you,” Hornbacher clearly blurs the blurs the boundariesbetween the “normal”
and the disabled. In fitting “you” so easily into this situation that is “not
at all uncommon” (279), Hornbacher makes “you” as disabled as “I” is.

The pronoun “you”
fulfills a strong function as both a normalizing and empathetic vehicle. But Hornbacher
then places “you” in a state of uneasiness similar to that of “I.” Instead of
deliberately projecting “you” onto the reader, and so forcing “you” to
participate in the activities described in the text, Hornbacher incorporates
the pronoun into the direct address of medical professionals who now enter the
paragraph and draw the “you” into a medicalized, therapeutic situation. If “I”
is subject to the uncertainty of external forces, “you” is subject to the
uncertainty experienced by patients imbricated in medical discourse. Edwards
argues that traditional medicalized discourse disallows effective communication
between medical professionals and their patients (241). Such ineffectiveness is
certainly apparent in this passage when professionals ask “you’ what “you” did
“before your eating disorder,” (279) and “you,” flummoxed by her awareness of
multiple selves, can only stare
back because “the word you means nothing
at all” (279).

Applied to
herself, “you” no longer has any meaning for the narrator. So she “aims” the
pronoun “back at” the medical professionals who are questioning her, shifting
its referent from the narrator to the medical community: “Are you referring to
Marya, the constellation of suicidal symptoms?” (279). Does this shift thereby
project the identity assigned to her by the medical community unto the medical
professionals themselves? If “you” means “nothing at all” (279), “you” can be
anyone – or no one.

By so closely
juxtaposing her normalized, empathetic “you” with a “you” applied to the
medical practitioners, Hornbacher refuses the identities ascribed to her
throughout treatment by ascribing them to her medical caretakers. “How do you
understand yourself in the context of these
labels?” she seems to ask.In her
conflation of two ascriptions of “you,” Hornbacher forces medicalized
identities back onto the professionals who assigned them, and so reflects
common professional misunderstanding of her all-too-common condition. By
responding to the medical professionals with a rhetorical question employing
“you,” Hornbacher re-casts their question, “What did you do before your eating disorder?” (279), as ludicrous.

In these multiple
ascriptions, the ever-shifting and illusive referent “you” answers the
political challenge of women’s life writing, as Buss described it (97).Here the referent for “you” is uncertain
– it means nothing, or it means everything, as Hornbacher applies it to various
people in turn. The “you” as the narrator, then the reader, then again the
medical professional, is variously directed back by each of these in turn. The
reader may choose to empathize with “you,” while the medical professionals
ascribe various identities to “you.” In this shift of referents, “you”
represents the disabling effects of a culture that limits the gendered body by
subjecting it to external forces – most notable, the medical interpretation and
treatment of a distinctly feminized illness.

Near
the end of this passage, Hornbacher refers to “Marya” as a third-person
singular character whose identity never settles on any one of the terms applied
to her by the medical community. After the “I” emerges from the hospital, after
the “you” displays confusion, after all the clinical evaluations and labels,
the name of the narrator means little in relation to the various social
constructions of her illness. Through illness and treatment, the narrator has
lost any sense of a coherent self.

The
final pages of Horbacher’s memoir offer no resolution to the dis-integration
that she has so minutely described. The narrator is at turns dismissive,
declaring that “[w]anting to be healthy is seen as really weird” (283), “healed” (“You fix yourself. It is the
hardest thing I have ever done” (284)), and unsure (the section entitled
“Present Day” recounts the still very active struggle she has with Anorexia
Nervosa). In the context of such a tumultuous disease, the narrator’s identity
has become dis-integrated. The many selves that lie within the individual can
no longer be described in a narrative with a multi-faceted, yet unified
narrator.Because she lacks
coherence, the narrator offers the projective surface of the female body, on
which western medicine and culture both play out conventional power dynamics.
Both medicine and culture vie to be the source of unification for the
dis-integrated narrator. Medicine provides a story of diagnosis and treatment;
culture, a story of expectations for gender performativity. In both of these
narrative frameworks, the dis-integrated individual is stripped of the ability
to negotiate her own coherent self.

Hornbacher ends
her memoir with a testimony to her loss of agency: “And then it [my heart]
tumbles into sleep, grabbing me by the hair and pulling me down into these
watery sleeps that are so terribly deep and cold” (289). In the end, it is this
larger medical discourse – the one that has literally defined the workings of
her body, the one that has told her that her hearts beats are irregular – that
maintains control over “me.”

IV. Women’s Life Writing,
Extended

Marya
Hornbacher’s memoir closes with a six-page bibliography of “book-length texts”
(291), which excludes many other sources: “the articles in scholarly, medical,
and psychiatric journals consulted . . . would be too numerous to cite” (291).
The presence of such an extensive body of research, as well as various
citations and footnotes throughout her text, situated Hornbacher’s memoir
within a large body of clinical literature. In its attention to the narrator’s
social and political climate, the text also challenges the boundaries of
clinical literature, extending the scope of that genre by drawing on the
resources of the tradition of women’s life writing. In her introduction,
Hornbacher describes that the narrative that follows as is stereotypical of
eating-disordered patients: “female, white young, middle-class” (7). By
creating a narrative belonging to “the stereotype,” Hornbacher casts her text
as a case study. By reading her memoir as a case study, we can come to
understand, in clinical terms, how an eating disorder might manifest itself in
an individual life.

And
yet immediately after she claims that her story is “stereotypical” – and so
perfectly exemplary of a documented disorder – Hornbacher resists the confines
of the clinical structure within which shepresents herself: “I wrote this because I object to the
homogenizing, the inaccurate trend in the majority of eating disorders
literature that tends to generalize the part from the whole” (7). Instead,
Hornbacher explains, she will present her disorder as “an attempt to find an
identity” (6). Hornbacher’s introduction thus sets up her narrative as a
negotiation between genres. She works within the genre of the clinical case
study, personalizing it, extending it to a larger audience, and adding the
political and sociocultural realms which such studies generally eschew; she
does so by interweaving clinical “objectivity” with subjective techniques drawn
from the literary genre of memoir.

Hornbacher’s
text exemplifies the “rhetoric of uncertainty” which Heilbrun describes as
central to autobiography; it does so by moving from introspection “outward”
(18, 24). Benstock identifies this “outward” gesture as the embrace of personal
experience by a larger population (8); women’s autobiography, according to her
description, encapsulates not only the self but the political collective of
which the self is a part. It is this move that, I argue, Hornbacher
accomplishes.

Hornbacher
capitalizes on the multiplicity inherent in this interpretation of the
tradition of women’s life writing by using multiple pronouns throughout her
text. “I”, or the self specific to the narrator who owns the details of her
particular life, goes to her aunt and uncle’s house for a meal of French bread
and spaghetti (175). This “I” specifically remembers buttering that French
bread and then throwing it up later in the evening, before she sleeps on her
mother’s lap (175). “You” and “we,” in contrast, are used to mark “ownership”
of nonspecific details applicable to a larger community. “We” refers to
patients who are eating disordered: “we” have “assertiveness groups”and “nutrition classes” (155), “we” are
“[a]noretics [with] strange shopping lists” (237). By and large, “we”
represents a collective outside of the presumed normal; it is often through
“we” that the “I” projects a singular experience, thus multiplying and depersonalizing
it. “You” is often broader than “we”: “you” forces every reader to occupy the
place of “I.” Chapter 4 of Wasted, for
example, opens with eight pages in which the only pronoun is “you.” In these
pages, “you” are taken through a hospital stay, given slippers, figure out
which nurses to dislike, and are stripped of “forbidden things . . . [r]azors,
matches, cigarettes” (145, 149). Telling the reader what is happening to “you”
extends the clinical experience beyond both that of the singular “I” and of the
collective “we”: it makes the reader to occupy the space of being disabled.

By
constantly shifting the pronouns in this autobiographical writing, Hornbacher
effectively reframes a singular experience both as clinical and sociopolitical.
By making not just “you” ill, but the entire communal “we” disabled, Hornbacher
redefines eating disorders: rather than only psychiatric problems requiring
medical treatments, she represents them as conditions situated within a
cultural context that propagates their development and prolongation. Wendell
argues that “[p]aradigms of health and ideas about appropriate kinds and levels
of performance are culturally dependent” (245). Because society is organized
around normative behavior, it treats difference as a problem requiring
alteration. As McDermott and Varenne show, the structure of ability we call
“culture” thus both creates and maintains disability; Hornbacher’s pronominal
use highlights this debilitating consequence of the construction of the
normative. By applying disability first to “you,” then marking it powerful
enough to create a communal “we,” Hornbacher’s prose makes the constructed-ness
of disability transparent by refusing any pronominal divide between the
normative and the disabled, between the experience of the patient and of the
“well.”

In refusing
divides between herself, her audience, and a larger community by employing
varied pronouns, Hornbacher, in addition to telling the story of her own
multiple selves, creates a cultural narrative that also negotiates the
challenge of stability versus multiplicity. Buss explains that the challenge of
the female autobiographer is presenting a decentered, multiplied self as
unified in the context of external, dominating forces.Hornbacher’s “I” situates the author’s
multiplied individual self within a coherent narrative, drawing on stable
personal details of her one, specific life to unify the chaos brought by the
cultural interpretations of her feminized body and illness. Thus, the “I” shows
Hornbacher’s individual negotiation of the challenge of women’s life writing.

Extending this
negotiation is Hornbacher’s remaining pronouns, which work to break the divide
between the pathology of the individual and that of society. In extending her
individual pathology to “you,” “we,” “her,” and “them,” Hornbacher exemplifies
a way in which women’s life writing becomes less individual and more
collective. All of her pronouns are collected under the same cultural forces,
and all are interrelated, switching referents as Hornbacher uses them
interchangeably, to highlight the multiplicity of all individuals within
society.Hornbacher thus not only
tells her own story in a unified, multiplied way, but she also tells a larger
cultural story of stability in the presence of multiplicity by eliminating the
boundary between individual and collective pathology. Hornbacher’s pronominal
switching then highlights an expanded negotiation of Buss’s dilemma and brings
a greater emphasis on society at large to the genre of women’s autobiographical
writing.

By reframing the
clinical experience as sociopolitical and by doing so in the context of the
memoiric genre and shifting pronouns, Hornbacher reframes the scope of women’s
life writing, extending what once historically focused on the masculinized, individualized,
unified autobiographical self to a collective societal narrative that focuses
on the stability and multiplicity of us all.